Plant-Based Diets as the Nutritional Equivalent of Quitting Smoking

The Best Kept Secret in Medicine.jpeg

Despite the most widely accepted and well-established chronic disease practice guidelines uniformly calling for lifestyle change as the first line of therapy, doctors often don't follow these recommendations. As seen in my video, The Best Kept Secret in Medicine, lifestyle interventions are not only safer and cheaper but often more effective in reducing heart disease and failure, hypertension, stroke, cancer, diabetes, and deaths from all causes than nearly any other medical intervention.

"Some useful lessons may come from the war on tobacco," Dr. Neal Barnard wrote in the American Medical Association's ethics journal. When he stopped smoking himself in the 1980s, the lung cancer death rate was peaking in the United States. As the prevalence of smoking dropped, so have lung cancer rates. No longer were doctors telling patients to "[g]ive your throat a vacation" by smoking a fresh cigarette. Doctors realized they were "more effective at counseling patients to quit smoking if they no longer had tobacco stains on their own fingers." "In other words, doctors went from being bystanders--or even enablers--to leading the fight against smoking." And today, says Dr. Barnard, "Plant-based diets are the nutritional equivalent of quitting smoking."

From an editorial in the journal Alternative Therapies in Health and Medicine: "If we were to gather the world's top nutrition scientists and experts (free from food industry influence), there would be very little debate about the essential properties of good nutrition. Unfortunately, most doctors are nutritionally illiterate. And worse, they don't know how to use the most powerful medicine available to them: food."

Physician advice matters. When doctors told patients to improve their diets by cutting down on meat, dairy, and fried foods, patients were more likely to make dietary changes. It may work even better if doctors practice what they preach. Researchers at Emory University randomized patients to watch one of two videos. In one video, a physician briefly mentioned her personal dietary and exercise practices and visible on her desk were both a bike helmet and an apple. In the other video, she did not discuss her personal healthy practices, and the helmet and apple were missing. In both videos, the doctor advised the patients to cut down on meat, not usually have meat for breakfast, and have no meats for lunch or dinner at least half the time. In the disclosure video, the physician related that she herself had successfully cut down on meat. Perhaps not surprisingly, patients rated that physician to be more believable and motivating. Physicians who walk the walk--literally--and have healthier eating habits not only tend to counsel more about exercise and diet, but have been found to seem more credible or motivating when they do so.

It may also make them better doctors. A randomized controlled intervention to clean up doctors' diets, called the Promoting Health by Self Experience (PHASE) trial, found that healthcare providers' personal lifestyles were correlated directly with their clinical performance. Healthcare providers' improved wellbeing and lifestyle cascaded to the patients and clinics, suggesting an additional strategy to achieve successful health promotion.

Are you ready for the best kept secret in medicine? Given the right conditions, the body can heal itself. For example, treating cardiovascular disease with appropriate dietary changes is good medicine, reducing mortality without any adverse effects. We should keep doing research, certainly, but educating physicians and patients alike about the existing knowledge regarding the power of nutrition as medicine may be the best investment we can make.

Of course, to advise patients about nutrition, physicians first have to educate themselves, as it is unlikely they received formal nutrition education during their medical training:

For more on the power of healthy living, see:

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank. This image has been modified.

Original Link

Plant-Based Diets as the Nutritional Equivalent of Quitting Smoking

The Best Kept Secret in Medicine.jpeg

Despite the most widely accepted and well-established chronic disease practice guidelines uniformly calling for lifestyle change as the first line of therapy, doctors often don't follow these recommendations. As seen in my video, The Best Kept Secret in Medicine, lifestyle interventions are not only safer and cheaper but often more effective in reducing heart disease and failure, hypertension, stroke, cancer, diabetes, and deaths from all causes than nearly any other medical intervention.

"Some useful lessons may come from the war on tobacco," Dr. Neal Barnard wrote in the American Medical Association's ethics journal. When he stopped smoking himself in the 1980s, the lung cancer death rate was peaking in the United States. As the prevalence of smoking dropped, so have lung cancer rates. No longer were doctors telling patients to "[g]ive your throat a vacation" by smoking a fresh cigarette. Doctors realized they were "more effective at counseling patients to quit smoking if they no longer had tobacco stains on their own fingers." "In other words, doctors went from being bystanders--or even enablers--to leading the fight against smoking." And today, says Dr. Barnard, "Plant-based diets are the nutritional equivalent of quitting smoking."

From an editorial in the journal Alternative Therapies in Health and Medicine: "If we were to gather the world's top nutrition scientists and experts (free from food industry influence), there would be very little debate about the essential properties of good nutrition. Unfortunately, most doctors are nutritionally illiterate. And worse, they don't know how to use the most powerful medicine available to them: food."

Physician advice matters. When doctors told patients to improve their diets by cutting down on meat, dairy, and fried foods, patients were more likely to make dietary changes. It may work even better if doctors practice what they preach. Researchers at Emory University randomized patients to watch one of two videos. In one video, a physician briefly mentioned her personal dietary and exercise practices and visible on her desk were both a bike helmet and an apple. In the other video, she did not discuss her personal healthy practices, and the helmet and apple were missing. In both videos, the doctor advised the patients to cut down on meat, not usually have meat for breakfast, and have no meats for lunch or dinner at least half the time. In the disclosure video, the physician related that she herself had successfully cut down on meat. Perhaps not surprisingly, patients rated that physician to be more believable and motivating. Physicians who walk the walk--literally--and have healthier eating habits not only tend to counsel more about exercise and diet, but have been found to seem more credible or motivating when they do so.

It may also make them better doctors. A randomized controlled intervention to clean up doctors' diets, called the Promoting Health by Self Experience (PHASE) trial, found that healthcare providers' personal lifestyles were correlated directly with their clinical performance. Healthcare providers' improved wellbeing and lifestyle cascaded to the patients and clinics, suggesting an additional strategy to achieve successful health promotion.

Are you ready for the best kept secret in medicine? Given the right conditions, the body can heal itself. For example, treating cardiovascular disease with appropriate dietary changes is good medicine, reducing mortality without any adverse effects. We should keep doing research, certainly, but educating physicians and patients alike about the existing knowledge regarding the power of nutrition as medicine may be the best investment we can make.

Of course, to advise patients about nutrition, physicians first have to educate themselves, as it is unlikely they received formal nutrition education during their medical training:

For more on the power of healthy living, see:

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank. This image has been modified.

Original Link

How to Treat High Blood Pressure with Diet

How to Treat High Blood Pressure with Diet.jpeg

High blood pressure ranks as the number-one risk factor for death and disability in the world. In my video, How to Prevent High Blood Pressure with Diet, I showed how a plant-based diet may prevent high blood pressure. But what do we do if we already have it? That's the topic of How to Treat High Blood Pressure with Diet.

The American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention recommend lifestyle modification as the first-line treatment. If that doesn't work, patients may be prescribed a thiazide diuretic (commonly known as a water pill) before getting even more meds until their blood pressure is forced down. Commonly, people will end up on three drugs, though researchers are experimenting with four at a time. Some patients even end up on five different meds.

What's wrong with skipping the lifestyle modification step and jumping straight to the drugs? Because drugs don't treat the underlying cause of high blood pressure yet can cause side effects. Less than half of patients stick with even the first-line drugs, perhaps due to such adverse effects as erectile dysfunction, fatigue, and muscle cramps.

What are the recommended lifestyle changes? The AHA, ACC, and CDC recommend controlling one's weight, salt, and alcohol intake, engaging in regular exercise, and adopting a DASH eating plan.

The DASH diet has been described as a lactovegetarian diet, but it's not. It emphasizes fruits, vegetables, and low-fat dairy, but only a reduction in meat consumption. Why not vegetarian? We've known for decades that animal products are significantly associated with blood pressure. In fact, if we take vegetarians and give them meat (and pay them enough to eat it!), we can watch their blood pressures go right up.

I've talked about the benefits to getting blood pressure down as low as 110 over 70. But who can get that low? Populations centering their diets around whole plant foods. Rural Chinese have been recorded with blood pressures averaging around 110 over 70 their whole lives. In rural Africa, the elderly have perfect blood pressure as opposed to hypertension. What both diets share in common is that they're plant-based day-to-day, with meat only eaten on special occasion.

How do we know it's the plant-based nature of their diets that was so protective? Because in the Western world, as the American Heart Association has pointed out, the only folks getting down that low were those eating strictly plant-based diets, coming out about 110 over 65.

So were the creators of the DASH diet just not aware of this landmark research done by Harvard's Frank Sacks? No, they were aware. The Chair of the Design Committee that came up with the DASH diet was Dr. Sacks himself. In fact, the DASH diet was explicitly designed with the number-one goal of capturing the blood pressure-lowering benefits of a vegetarian diet, yet including enough animal products to make it "palatable" to the general public.

You can see what they were thinking. Just like drugs never work--unless you actually take them. Diet never work--unless you actually eat them. So what's the point of telling people to eat strictly plant-based if few people will do it? So by soft-peddling the truth and coming up with a compromise diet you can imagine how they were thinking that on a population clae they might be doing more good. Ok, but tell that to the thousand U.S. families a day that lose a loved one to high blood pressure. Maybe it's time to start telling the American public the truth.

Sacks himself found that the more dairy the lactovegetarians ate, the higher their blood pressures. But they had to make the diet acceptable. Research has since shown that it's the added plant foods--not the changes in oil, sweets, or dairy--that appears to the critical component of the DASH diet. So why not eat a diet composed entirely of plant foods?

A recent meta-analysis showed vegetarian diets are good, but strictly plant-based diets may be better. In general, vegetarian diets provide protection against cardiovascular diseases, some cancers, and even death. But completely plant-based diets seem to offer additional protection against obesity, hypertension, type-2 diabetes, and heart disease mortality. Based on a study of more than 89,000 people, those eating meat-free diets appear to cut their risk of high blood pressure in half. But those eating meat-free, egg-free, and dairy-free may have 75% lower risk.

What if we're already eating a whole food, plant-based diet, no processed foods, no table salt, yet still not hitting 110 over 70? Here are some foods recently found to offer additional protection: Just a few tablespoons of ground flaxseeds a day was 2 to 3 times more potent than instituting an aerobic endurance exercise program and induced one of the most powerful, antihypertensive effects ever achieved by a diet-related intervention. Watermelon also appears to be extraordinary, but you'd have to eat around 2 pounds a day. Sounds like my kind of medicine, but it's hard to get year-round (at least in my neck of the woods). Red wine may help, but only if the alcohol has been taken out. Raw vegetables or cooked? The answer is both, though raw may work better. Beans, split peas, chickpeas, and lentils may also help a bit.

Kiwifruits don't seem to work at all, even though the study was funded by a kiwifruit company. Maybe they should have taken direction from the California Raisin Marketing Board, which came out with a study showing raisins can reduce blood pressure, but only, apparently, compared to fudge cookies, Cheez-Its, and Chips Ahoy.

The DASH diet is one of the best studied, and it consistently ranks as US News & World Report's #1 diet. It's one of the few diets that medical students are taught about in medical school. I was so fascinated to learn of its origins as a compromise between practicality and efficacy.

I've talked about the patronizing attitude many doctors have that patients can't handle the truth in:

What would hearing the truth from your physician sound like? See Fully Consensual Heart Disease Treatment and The Actual Benefit of Diet vs. Drugs.

For more on what plants can do for high blood pressure, see:

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank. This image has been modified.

Original Link

How to Treat High Blood Pressure with Diet

How to Treat High Blood Pressure with Diet.jpeg

High blood pressure ranks as the number-one risk factor for death and disability in the world. In my video, How to Prevent High Blood Pressure with Diet, I showed how a plant-based diet may prevent high blood pressure. But what do we do if we already have it? That's the topic of How to Treat High Blood Pressure with Diet.

The American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention recommend lifestyle modification as the first-line treatment. If that doesn't work, patients may be prescribed a thiazide diuretic (commonly known as a water pill) before getting even more meds until their blood pressure is forced down. Commonly, people will end up on three drugs, though researchers are experimenting with four at a time. Some patients even end up on five different meds.

What's wrong with skipping the lifestyle modification step and jumping straight to the drugs? Because drugs don't treat the underlying cause of high blood pressure yet can cause side effects. Less than half of patients stick with even the first-line drugs, perhaps due to such adverse effects as erectile dysfunction, fatigue, and muscle cramps.

What are the recommended lifestyle changes? The AHA, ACC, and CDC recommend controlling one's weight, salt, and alcohol intake, engaging in regular exercise, and adopting a DASH eating plan.

The DASH diet has been described as a lactovegetarian diet, but it's not. It emphasizes fruits, vegetables, and low-fat dairy, but only a reduction in meat consumption. Why not vegetarian? We've known for decades that animal products are significantly associated with blood pressure. In fact, if we take vegetarians and give them meat (and pay them enough to eat it!), we can watch their blood pressures go right up.

I've talked about the benefits to getting blood pressure down as low as 110 over 70. But who can get that low? Populations centering their diets around whole plant foods. Rural Chinese have been recorded with blood pressures averaging around 110 over 70 their whole lives. In rural Africa, the elderly have perfect blood pressure as opposed to hypertension. What both diets share in common is that they're plant-based day-to-day, with meat only eaten on special occasion.

How do we know it's the plant-based nature of their diets that was so protective? Because in the Western world, as the American Heart Association has pointed out, the only folks getting down that low were those eating strictly plant-based diets, coming out about 110 over 65.

So were the creators of the DASH diet just not aware of this landmark research done by Harvard's Frank Sacks? No, they were aware. The Chair of the Design Committee that came up with the DASH diet was Dr. Sacks himself. In fact, the DASH diet was explicitly designed with the number-one goal of capturing the blood pressure-lowering benefits of a vegetarian diet, yet including enough animal products to make it "palatable" to the general public.

You can see what they were thinking. Just like drugs never work--unless you actually take them. Diet never work--unless you actually eat them. So what's the point of telling people to eat strictly plant-based if few people will do it? So by soft-peddling the truth and coming up with a compromise diet you can imagine how they were thinking that on a population clae they might be doing more good. Ok, but tell that to the thousand U.S. families a day that lose a loved one to high blood pressure. Maybe it's time to start telling the American public the truth.

Sacks himself found that the more dairy the lactovegetarians ate, the higher their blood pressures. But they had to make the diet acceptable. Research has since shown that it's the added plant foods--not the changes in oil, sweets, or dairy--that appears to the critical component of the DASH diet. So why not eat a diet composed entirely of plant foods?

A recent meta-analysis showed vegetarian diets are good, but strictly plant-based diets may be better. In general, vegetarian diets provide protection against cardiovascular diseases, some cancers, and even death. But completely plant-based diets seem to offer additional protection against obesity, hypertension, type-2 diabetes, and heart disease mortality. Based on a study of more than 89,000 people, those eating meat-free diets appear to cut their risk of high blood pressure in half. But those eating meat-free, egg-free, and dairy-free may have 75% lower risk.

What if we're already eating a whole food, plant-based diet, no processed foods, no table salt, yet still not hitting 110 over 70? Here are some foods recently found to offer additional protection: Just a few tablespoons of ground flaxseeds a day was 2 to 3 times more potent than instituting an aerobic endurance exercise program and induced one of the most powerful, antihypertensive effects ever achieved by a diet-related intervention. Watermelon also appears to be extraordinary, but you'd have to eat around 2 pounds a day. Sounds like my kind of medicine, but it's hard to get year-round (at least in my neck of the woods). Red wine may help, but only if the alcohol has been taken out. Raw vegetables or cooked? The answer is both, though raw may work better. Beans, split peas, chickpeas, and lentils may also help a bit.

Kiwifruits don't seem to work at all, even though the study was funded by a kiwifruit company. Maybe they should have taken direction from the California Raisin Marketing Board, which came out with a study showing raisins can reduce blood pressure, but only, apparently, compared to fudge cookies, Cheez-Its, and Chips Ahoy.

The DASH diet is one of the best studied, and it consistently ranks as US News & World Report's #1 diet. It's one of the few diets that medical students are taught about in medical school. I was so fascinated to learn of its origins as a compromise between practicality and efficacy.

I've talked about the patronizing attitude many doctors have that patients can't handle the truth in:

What would hearing the truth from your physician sound like? See Fully Consensual Heart Disease Treatment and The Actual Benefit of Diet vs. Drugs.

For more on what plants can do for high blood pressure, see:

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank. This image has been modified.

Original Link

Treating Kidney Stones with Diet

Treating Kidney Stones with Diet.jpeg

Studies suggest that excessive consumption of animal protein poses a risk of kidney stone formation, likely due to the acid load contributed by the high content of sulfur-containing amino acids in animal protein, a topic I explore in my video, Preventing Kidney Stones with Diet. What about treating kidney stones, though? I discuss that in How to Treat Kidney Stones with Diet. Most stones are calcium oxalate, formed like rock candy when the urine becomes supersaturated. Doctors just assumed that if stones are made out of calcium, we simply have to tell people to reduce their calcium intake. That was the dietary gospel for kidney stone sufferers until a 2002 study published in the New England Journal of Medicine pitted two diets against one another--a low-calcium diet versus a diet low in animal protein and salt. The restriction of animal protein and salt provided greater protection, cutting the risk of having another kidney stone within five years in half.

What about cutting down on oxalates, which are concentrated in certain vegetables? A recent study found there was no increased risk of stone formation with higher vegetable intake. In fact, greater dietary intake of whole plant foods, fruits, and vegetables were each associated with reduced risk independent of other known risk factors for kidney stones. This means we may get additional benefits bulking up on plant foods in addition to just restricting animal foods.

A reduction in animal protein not only reduces the production of acids within the body, but should also limit the excretion of urate, uric acid crystals that can act as seeds to form calcium stones or create entire stones themselves. (Uric acid stones are the second most common kidney stones after calcium.)

There are two ways to reduce uric acid levels in the urine: a reduction of animal protein ingestion, or a variety of drugs. Removing all meat--that is, switching from the standard Western diet to a vegetarian diet--can remove 93% of uric acid crystallization risk within days.

To minimize uric acid crystallization, the goal is to get our urine pH up to ideally as high as 6.8. A number of alkalinizing chemicals have been developed for just this purpose, but we can naturally alkalize our urine up to the recommended 6.8 using purely dietary means. Namely, by removing all meat, someone eating the standard Western diet can go from a pH of 5.95 to the goal target of 6.8--simply by eating plant-based. As I describe in my video, Testing Your Diet with Pee & Purple Cabbage, we can inexpensively test our own diets with a little bathroom chemistry, for not all plant foods are alkalinizing and not all animal foods are equally acidifying.

A Load of Acid to Kidney Evaluation (LAKE) score has been developed to take into account both the acid load of foods and their typical serving sizes. It can be used to help people modify their diet for the prevention of both uric acid and calcium kidney stones, as well as other diseases. What did researchers find? The single most acid-producing food is fish, like tuna. Then, in descending order, are pork, then poultry, cheese (though milk and other dairy are much less acidifying), and beef followed by eggs. (Eggs are actually more acidic than beef, but people tend to eat fewer eggs in one sitting.) Some grains, like bread and rice, can be a little acid-forming, but pasta is not. Beans are significantly alkaline-forming, but not as much as fruits or even better, vegetables, which are the most alkaline-forming of all.

Through dietary changes alone, we may be able to dissolve uric acid stones completely and cure patients without drugs or surgery.

To summarize, the most important things we can do diet-wise is to drink 10 to 12 cups of water a day, reduce animal protein, reduce salt, and eat more vegetables and more vegetarian.

Want to try to calculate their LAKE score for the day? Just multiply the number of servings you have of each of the food groups listed in the graph in the video times the score.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank

Original Link

Treating Kidney Stones with Diet

Treating Kidney Stones with Diet.jpeg

Studies suggest that excessive consumption of animal protein poses a risk of kidney stone formation, likely due to the acid load contributed by the high content of sulfur-containing amino acids in animal protein, a topic I explore in my video, Preventing Kidney Stones with Diet. What about treating kidney stones, though? I discuss that in How to Treat Kidney Stones with Diet. Most stones are calcium oxalate, formed like rock candy when the urine becomes supersaturated. Doctors just assumed that if stones are made out of calcium, we simply have to tell people to reduce their calcium intake. That was the dietary gospel for kidney stone sufferers until a 2002 study published in the New England Journal of Medicine pitted two diets against one another--a low-calcium diet versus a diet low in animal protein and salt. The restriction of animal protein and salt provided greater protection, cutting the risk of having another kidney stone within five years in half.

What about cutting down on oxalates, which are concentrated in certain vegetables? A recent study found there was no increased risk of stone formation with higher vegetable intake. In fact, greater dietary intake of whole plant foods, fruits, and vegetables were each associated with reduced risk independent of other known risk factors for kidney stones. This means we may get additional benefits bulking up on plant foods in addition to just restricting animal foods.

A reduction in animal protein not only reduces the production of acids within the body, but should also limit the excretion of urate, uric acid crystals that can act as seeds to form calcium stones or create entire stones themselves. (Uric acid stones are the second most common kidney stones after calcium.)

There are two ways to reduce uric acid levels in the urine: a reduction of animal protein ingestion, or a variety of drugs. Removing all meat--that is, switching from the standard Western diet to a vegetarian diet--can remove 93% of uric acid crystallization risk within days.

To minimize uric acid crystallization, the goal is to get our urine pH up to ideally as high as 6.8. A number of alkalinizing chemicals have been developed for just this purpose, but we can naturally alkalize our urine up to the recommended 6.8 using purely dietary means. Namely, by removing all meat, someone eating the standard Western diet can go from a pH of 5.95 to the goal target of 6.8--simply by eating plant-based. As I describe in my video, Testing Your Diet with Pee & Purple Cabbage, we can inexpensively test our own diets with a little bathroom chemistry, for not all plant foods are alkalinizing and not all animal foods are equally acidifying.

A Load of Acid to Kidney Evaluation (LAKE) score has been developed to take into account both the acid load of foods and their typical serving sizes. It can be used to help people modify their diet for the prevention of both uric acid and calcium kidney stones, as well as other diseases. What did researchers find? The single most acid-producing food is fish, like tuna. Then, in descending order, are pork, then poultry, cheese (though milk and other dairy are much less acidifying), and beef followed by eggs. (Eggs are actually more acidic than beef, but people tend to eat fewer eggs in one sitting.) Some grains, like bread and rice, can be a little acid-forming, but pasta is not. Beans are significantly alkaline-forming, but not as much as fruits or even better, vegetables, which are the most alkaline-forming of all.

Through dietary changes alone, we may be able to dissolve uric acid stones completely and cure patients without drugs or surgery.

To summarize, the most important things we can do diet-wise is to drink 10 to 12 cups of water a day, reduce animal protein, reduce salt, and eat more vegetables and more vegetarian.

Want to try to calculate their LAKE score for the day? Just multiply the number of servings you have of each of the food groups listed in the graph in the video times the score.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank

Original Link

How Much Nutrition Education Do Doctors Get?

How Much Nutrition Education Do Doctors Get?.jpeg

In the United States, most deaths are preventable and related to nutrition. Given that the number-one cause of death and the number-one cause of disability in this country is diet, surely nutrition is the number-one subject taught in medical school, right? Sadly, that is not the case.

As shown in my video, Physician's May Be Missing Their Most Important Tool, a group of prominent physicians wrote in 2014 that "nutrition receives little attention in medical practice" and "the reason stems, in large part, from the severe deficiency of nutrition education at all levels of medical training." They note this is particularly shocking since it has been proven that a whole foods, plant-based diet low in animal products and refined carbohydrates can reverse coronary heart disease--our number-one killer--and provide potent protection against other leading causes fof death such as cancer and type 2 diabetes.

So, how has medical education been affected by this knowledge? Medical students are still getting less than 20 hours of nutrition education over 4 years, and even most of that has limited clinical relevance. Thirty years ago, only 37 percent of medical schools had a single course in nutrition. According to the most recent national survey, that number has since dropped to 27 percent. And it gets even worse after students graduate.

According to the official list of all the requirements for those specializing in cardiology, Fellows must perform at least 50 stress tests, participate in at least 100 catheterizations, and so on. But nowhere in the 34-page list of requirements is there any mention of nutrition. Maybe they leave that to the primary care physicians? No. In the official 35-page list of requirements for internal medicine doctors, once again, nutrition doesn't get even a single mention.

There are no requirements for nutrition before medical school either. Instead, aspiring doctors need to take courses like calculus, organic chemistry, and physics. Most of these common pre-med requirements are irrelevant to the practice of medicine and are primarily used to "weed out" students. Shouldn't we be weeding out based on skills a physician actually uses? An important paper published in the Archives of Internal Medicine states: "The pernicious and myopic nature of this process of selection becomes evident when one realizes that those qualities that may lead to success in a premedical organic chemistry course...[like] a brutal competitiveness, an unquestioning, meticulous memorization, are not necessarily the same qualities that are present in a competent clinician."

How about requiring a course in nutrition instead of calculus, or ethics instead of physics?

Despite the neglect of nutrition in medical education, physicians are considered by the public to be among the most trusted sources for information related to nutrition. But if doctors don't know what they're talking about, they could actually be contributing to diet-related disease. If we're going to stop the prevailing trend of chronic illness in the United States, physicians need to become part of the solution.

There's still a lot to learn about the optimal diet, but we don't need a single additional study to take nutrition education seriously right now. It's health care's low-hanging fruit. While we've had the necessary knowledge for some time, what we've been lacking is the will to put that knowledge into practice. If we emphasized the powerful role of nutrition, we could dramatically reduce suffering and needless death.

Take, for example, the "Million Hearts" initiative. More than 2 million Americans have a heart attack or stroke each year. In 2011, U.S. federal, state, and local government agencies launched the Million Hearts initiative to prevent 1 million of the 10 million heart attacks and strokes that will occur in the next 5 years. "But why stop at a million?" a doctor asked in the American Journal of Cardiology. Already, we possess all the information needed to eradicate atherosclerotic disease, which is our number-one killer while being virtually nonexistent in populations who consume plant-based diets. Some of the world's most renowned cardiovascular pathologists have stated we just need to get our cholesterol low enough in order to not only prevent--but also reverse--the disease in more than 80% of patients. We can open up arteries without drugs and surgery, and stabilize or improve blood flow in 99% of those who choose to eat healthily and clean up their bad habits. We can essentially eliminate our risk of having a heart attack even in the most advanced cases of heart disease.

Despite this, medical students aren't even taught these concepts while they're in school. Instead, the focus is on cutting people open, which frequently provides only symptomatic relief because we're not treating the actual cause of the disease. Fixing medical education is the solution to this travesty. Knowledge of nutrition can help doctors eradicate the world's leading killer.

I've previously addressed how Doctors Tend to Know Less Than They Think About Nutrition, which is no surprise given most medical schools in the United States fail to provide even a bare minimum of nutrition training (see Medical School Nutrition Education), with mainstream medical associations even actively lobbying against additional nutrition training.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank

Original Link

How Much Nutrition Education Do Doctors Get?

How Much Nutrition Education Do Doctors Get?.jpeg

In the United States, most deaths are preventable and related to nutrition. Given that the number-one cause of death and the number-one cause of disability in this country is diet, surely nutrition is the number-one subject taught in medical school, right? Sadly, that is not the case.

As shown in my video, Physician's May Be Missing Their Most Important Tool, a group of prominent physicians wrote in 2014 that "nutrition receives little attention in medical practice" and "the reason stems, in large part, from the severe deficiency of nutrition education at all levels of medical training." They note this is particularly shocking since it has been proven that a whole foods, plant-based diet low in animal products and refined carbohydrates can reverse coronary heart disease--our number-one killer--and provide potent protection against other leading causes fof death such as cancer and type 2 diabetes.

So, how has medical education been affected by this knowledge? Medical students are still getting less than 20 hours of nutrition education over 4 years, and even most of that has limited clinical relevance. Thirty years ago, only 37 percent of medical schools had a single course in nutrition. According to the most recent national survey, that number has since dropped to 27 percent. And it gets even worse after students graduate.

According to the official list of all the requirements for those specializing in cardiology, Fellows must perform at least 50 stress tests, participate in at least 100 catheterizations, and so on. But nowhere in the 34-page list of requirements is there any mention of nutrition. Maybe they leave that to the primary care physicians? No. In the official 35-page list of requirements for internal medicine doctors, once again, nutrition doesn't get even a single mention.

There are no requirements for nutrition before medical school either. Instead, aspiring doctors need to take courses like calculus, organic chemistry, and physics. Most of these common pre-med requirements are irrelevant to the practice of medicine and are primarily used to "weed out" students. Shouldn't we be weeding out based on skills a physician actually uses? An important paper published in the Archives of Internal Medicine states: "The pernicious and myopic nature of this process of selection becomes evident when one realizes that those qualities that may lead to success in a premedical organic chemistry course...[like] a brutal competitiveness, an unquestioning, meticulous memorization, are not necessarily the same qualities that are present in a competent clinician."

How about requiring a course in nutrition instead of calculus, or ethics instead of physics?

Despite the neglect of nutrition in medical education, physicians are considered by the public to be among the most trusted sources for information related to nutrition. But if doctors don't know what they're talking about, they could actually be contributing to diet-related disease. If we're going to stop the prevailing trend of chronic illness in the United States, physicians need to become part of the solution.

There's still a lot to learn about the optimal diet, but we don't need a single additional study to take nutrition education seriously right now. It's health care's low-hanging fruit. While we've had the necessary knowledge for some time, what we've been lacking is the will to put that knowledge into practice. If we emphasized the powerful role of nutrition, we could dramatically reduce suffering and needless death.

Take, for example, the "Million Hearts" initiative. More than 2 million Americans have a heart attack or stroke each year. In 2011, U.S. federal, state, and local government agencies launched the Million Hearts initiative to prevent 1 million of the 10 million heart attacks and strokes that will occur in the next 5 years. "But why stop at a million?" a doctor asked in the American Journal of Cardiology. Already, we possess all the information needed to eradicate atherosclerotic disease, which is our number-one killer while being virtually nonexistent in populations who consume plant-based diets. Some of the world's most renowned cardiovascular pathologists have stated we just need to get our cholesterol low enough in order to not only prevent--but also reverse--the disease in more than 80% of patients. We can open up arteries without drugs and surgery, and stabilize or improve blood flow in 99% of those who choose to eat healthily and clean up their bad habits. We can essentially eliminate our risk of having a heart attack even in the most advanced cases of heart disease.

Despite this, medical students aren't even taught these concepts while they're in school. Instead, the focus is on cutting people open, which frequently provides only symptomatic relief because we're not treating the actual cause of the disease. Fixing medical education is the solution to this travesty. Knowledge of nutrition can help doctors eradicate the world's leading killer.

I've previously addressed how Doctors Tend to Know Less Than They Think About Nutrition, which is no surprise given most medical schools in the United States fail to provide even a bare minimum of nutrition training (see Medical School Nutrition Education), with mainstream medical associations even actively lobbying against additional nutrition training.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank

Original Link

How Much Water Should We Drink Every Day?

How Much Water Should We Drink Every Day?.jpeg

More than 2000 years ago Hippocrates (460-377 BCE) said, "If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health." What does that mean when it comes to water? Water has been described as a neglected, unappreciated, and under-researched subject, and further complicating the issue, a lot of the papers extolling the need for proper hydration are funded by the bottled water industry.

It turns out the often quoted "drink at least eight glasses of water a day" dictum has little underpinning scientific evidence . Where did that idea come from? The recommendation was traced to a 1921 paper, in which the author measured his own pee and sweat and determined we lose about 3% of our body weight in water a day, or about 8 cups (see How Many Glasses of Water Should We Drink in a Day?). Consequently, for the longest time, water requirement guidelines for humanity were based on just one person.

There is evidence that not drinking enough may be associated with falls and fractures, heat stroke, heart disease, lung disorders, kidney disease, kidney stones, bladder and colon cancer, urinary tract infections, constipation, dry mouth, cavities, decreased immune function and cataract formation. The problem with many of these studies is that low water intake is associated with several unhealthy behaviors, such as low fruit and vegetable intake, more fast-food, less shopping at farmers markets. And who drinks lots of water? People who exercise a lot. No wonder they tend to have lower disease rates!

Only large and expensive randomized trials could settle these questions definitively. Given that water cannot be patented, such trials seem unlikely; who's going to pay for them? We're left with studies that find an association between disease and low water intake. But are people sick because they drink less, or are they drinking less because they're sick? There have been a few large prospective studies in which fluid intake is measured before disease develops. For example, a Harvard study of 48,000 men found that the risk of bladder cancer decreased by 7% for every extra daily cup of fluid we drink. Therefore, a high intake of water--like 8 cups a day--may reduce the risk of bladder cancer by about 50%, potentially saving thousands of lives.

The accompanying editorial commented that strategies to prevent the most prevalent cancers in the West are remarkably straightforward in principle. To prevent lung cancer, quit smoking; to prevent breast cancer, maintain your ideal body weight and exercise; and to prevent skin cancer, stay out of the sun. Now comes this seemingly simple way to reduce the risk of bladder cancer: drink more fluids.

Probably the best evidence we have for a cut off of water intake comes from the Adventist Health Study, in which 20,000 men and women were studied. About one-half were vegetarian, so they were also getting extra water by eating more fruits and vegetables. Those drinking 5 or more glasses of water a day had about half the risk of dying from heart disease compared to those who drank 2 or fewer glasses a day. Like the Harvard study, this protection was found after controlling for other factors such as diet and exercise. These data suggest that it was the water itself that was decreasing risk, perhaps by lowering blood viscosity (blood thickness).

Based on all the best evidence to date, authorities from Europe, the U.S. Institute of Medicine, and the World Health Organization recommend between 2.0 and 2.7 liters (8 to 11 cups) of water a day for women, and 2.5 to 3.7 liters (10 to 15 cups) a day for men. This includes water from all sources, not just beverages. We get about a liter from food and the water our body makes. So this translates into a recommendation for women to drink 4 to 7 cups of water a day and men 6 to 11 cups, assuming only moderate physical activity at moderate ambient temperatures.

We can also get water from all the other drinks we consume, including caffeinated drinks, with the exception of stronger alcoholic drinks like wines and spirits. Beer can leave you with more water than you started with, but wine actively dehydrates you. However, in the cancer and heart disease studies I mentioned above, the benefits were only found with increased water consumption, not other beverages.

I've previously touched on the cognitive benefits of proper hydration here: Does a Drink Of Water Make Children Smarter?

Surprised tea is hydrating? See my video Is Caffeinated Tea Dehydrating?

Surprised that the 8-a-day rested on such flimsy evidence? Unfortunately, so much of what we do in medicine has shaky underpinnings. That's the impetus behind the idea of evidence-based medicine (what a concept!). Ironically, this new movement may itself undermine some of the most effective treatments. See Evidence-Based Medicine or Evidence-Biased?

How else can we reduce our risk of bladder cancer? See Raw Broccoli and Bladder Cancer Survival.

What kind of water? I recommend tap water, which tends to be preferable from a chemical and microbial contamination standpoint. What about buying one of those fancy alkalizing machines? See Alkaline Water: a Scam?

It's so nice to have data on such a fundamental question. We have much to thank the Adventists for. You will see their studies cropping up frequently. See, for example, Plant-Based Diets and Diabetes, The Okinawa Diet: Living to 100, and Evidence-Based Eating.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank / Flickr. Image has been modified.

Original Link

How Much Water Should We Drink Every Day?

How Much Water Should We Drink Every Day?.jpeg

More than 2000 years ago Hippocrates (460-377 BCE) said, "If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health." What does that mean when it comes to water? Water has been described as a neglected, unappreciated, and under-researched subject, and further complicating the issue, a lot of the papers extolling the need for proper hydration are funded by the bottled water industry.

It turns out the often quoted "drink at least eight glasses of water a day" dictum has little underpinning scientific evidence . Where did that idea come from? The recommendation was traced to a 1921 paper, in which the author measured his own pee and sweat and determined we lose about 3% of our body weight in water a day, or about 8 cups (see How Many Glasses of Water Should We Drink in a Day?). Consequently, for the longest time, water requirement guidelines for humanity were based on just one person.

There is evidence that not drinking enough may be associated with falls and fractures, heat stroke, heart disease, lung disorders, kidney disease, kidney stones, bladder and colon cancer, urinary tract infections, constipation, dry mouth, cavities, decreased immune function and cataract formation. The problem with many of these studies is that low water intake is associated with several unhealthy behaviors, such as low fruit and vegetable intake, more fast-food, less shopping at farmers markets. And who drinks lots of water? People who exercise a lot. No wonder they tend to have lower disease rates!

Only large and expensive randomized trials could settle these questions definitively. Given that water cannot be patented, such trials seem unlikely; who's going to pay for them? We're left with studies that find an association between disease and low water intake. But are people sick because they drink less, or are they drinking less because they're sick? There have been a few large prospective studies in which fluid intake is measured before disease develops. For example, a Harvard study of 48,000 men found that the risk of bladder cancer decreased by 7% for every extra daily cup of fluid we drink. Therefore, a high intake of water--like 8 cups a day--may reduce the risk of bladder cancer by about 50%, potentially saving thousands of lives.

The accompanying editorial commented that strategies to prevent the most prevalent cancers in the West are remarkably straightforward in principle. To prevent lung cancer, quit smoking; to prevent breast cancer, maintain your ideal body weight and exercise; and to prevent skin cancer, stay out of the sun. Now comes this seemingly simple way to reduce the risk of bladder cancer: drink more fluids.

Probably the best evidence we have for a cut off of water intake comes from the Adventist Health Study, in which 20,000 men and women were studied. About one-half were vegetarian, so they were also getting extra water by eating more fruits and vegetables. Those drinking 5 or more glasses of water a day had about half the risk of dying from heart disease compared to those who drank 2 or fewer glasses a day. Like the Harvard study, this protection was found after controlling for other factors such as diet and exercise. These data suggest that it was the water itself that was decreasing risk, perhaps by lowering blood viscosity (blood thickness).

Based on all the best evidence to date, authorities from Europe, the U.S. Institute of Medicine, and the World Health Organization recommend between 2.0 and 2.7 liters (8 to 11 cups) of water a day for women, and 2.5 to 3.7 liters (10 to 15 cups) a day for men. This includes water from all sources, not just beverages. We get about a liter from food and the water our body makes. So this translates into a recommendation for women to drink 4 to 7 cups of water a day and men 6 to 11 cups, assuming only moderate physical activity at moderate ambient temperatures.

We can also get water from all the other drinks we consume, including caffeinated drinks, with the exception of stronger alcoholic drinks like wines and spirits. Beer can leave you with more water than you started with, but wine actively dehydrates you. However, in the cancer and heart disease studies I mentioned above, the benefits were only found with increased water consumption, not other beverages.

I've previously touched on the cognitive benefits of proper hydration here: Does a Drink Of Water Make Children Smarter?

Surprised tea is hydrating? See my video Is Caffeinated Tea Dehydrating?

Surprised that the 8-a-day rested on such flimsy evidence? Unfortunately, so much of what we do in medicine has shaky underpinnings. That's the impetus behind the idea of evidence-based medicine (what a concept!). Ironically, this new movement may itself undermine some of the most effective treatments. See Evidence-Based Medicine or Evidence-Biased?

How else can we reduce our risk of bladder cancer? See Raw Broccoli and Bladder Cancer Survival.

What kind of water? I recommend tap water, which tends to be preferable from a chemical and microbial contamination standpoint. What about buying one of those fancy alkalizing machines? See Alkaline Water: a Scam?

It's so nice to have data on such a fundamental question. We have much to thank the Adventists for. You will see their studies cropping up frequently. See, for example, Plant-Based Diets and Diabetes, The Okinawa Diet: Living to 100, and Evidence-Based Eating.

In health,

Michael Greger, M.D.

PS: If you haven't yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Image Credit: Sally Plank / Flickr. Image has been modified.

Original Link